BOOKING SURVEY

1

How do you currently wear your hair?* This field is required.Please select an option

Shaved

Short

Mid-Length

Long

2

On a scale of 1-10, how severe is your hair loss?* This field is required.Please select an option

1-3

4-6

7-9

10

3

Do you have any significant skin/scalp conditions?* This field is required.Please select an option below

YESNO

4

Do you use any hair treatments?

Hair Color or Bleach

Minoxidil

Keratin

UV Lights

5

What color is your natural hair?

Light (Blonde or Gray Hair)

Medium (Light Brown or Brown)

Dark (Black Hair)

6

What color is your skin tone?

Very Light

Light

Medium

Dark

7

What are your goals with SMP?

The Buzzed Look (Classic SMP)

Keep Hair Mid Length (Hair Thickening)

Keep Hair Long (Hair Thickening)

Still Not Sure

8

Do you understand that Scalp Micropigmentation is a scalp tattoo and in many cases will require you to wear your hair short?* This field is required.Please select an option below

YESNO

9

Select the Best Time For Us To Call You:* This field is required.We will discuss your options

10

Please enter your name:* This field is required.Please type your name below

First Name

Last Name

11

What is your email:* This field is required.Please type in your email address below

example@example.com

12

Please enter your Phone Number* This field is required.

Please enter a valid phone number.